What are the signs of Complex – PTSD

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Many people will have heard of the mental health condition called PTSD or what is clinically called Post-Traumatic Stress Disorder. 

However, complex PTSD may not be as commonly known, although it’s long-term effects can be just as severe.

What is Complex PTSD?

Post-Traumatic Stress Disorder generally arises from a single (albeit distressing) event, whereas C-PTSD is related to a sequence of events, or one prolonged event.

Symptoms of PTSD can arise or exacerbate when a person gets exposed to:

  • Domestic Violence
  • A natural disaster
  • Being involved in (or witnessing) a car accident
  • Being the victim of sexual abuse
  • The death of a loved one
  • Divorce
  • Being diagnosed with a serious illness 

PTSD is a common condition that affects 7-8 percent of the American population.

Diagnosing C-PTSD

Diagnosing C-PTSD has proved challenging for mental health professionals, the Diagnostic Statistical Manual (DSM 5), for instance, has not yet identified C-PTSD as a separate condition.

Borderline Personality Disorder vs C-PTSD

People experiencing symptoms of C-PTSD get diagnosed with having PTSD or Borderline Personality Disorder since the symptoms are similar.

Unfortunately, not all mental health professionals are aware of Complex PTSD, and this can result in people getting misdiagnosed – when their symptoms and experiences fit more closely with Complex Post Traumatic Stress.

Lack of guidance

A lack of guidance when it comes to the diagnostic criteria for people suffering from Complex – Post Traumatic Stress Disorder is rife within the mental health community – which can result in individuals with C-PTSD symptoms getting misdiagnosed.

However, mental health professionals may diagnose C-PTSD when a person has experienced ongoing trauma over a long period (chronic trauma).

What causes C-PTSD?

Complex: Post Traumatic Stress gets caused by severe, repeated trauma and abuse over a long period.

There is a wide range of events, physical, emotional, and mental that can trigger symptoms of C-PTSD – including:

  • Severe domestic violence
  • Torture
  • Childhood soldiering
  • Childhood abuse, abandonment, or neglect
  • Slavery

In these events, one person is under the control of another – perhaps someone more dominant, it is also likely that the victim is incapable of escaping or leaving the situation.

The difference between PTSD and C-PTSD

Traumatic Stress Disorder (PTSD) produces symptoms of complex PTSD, hence why they get lumped together.

However, both conditions, although a result of traumatic events, require different treatment and impact people in different ways.


PTSD first came about as a condition that affects veteran of war. 

Post Traumatic Stress Disorder gets caused by a wide range of traumatic events, such as:

  • Near-death experiences
  • Natural disasters
  • Car accidents
  • Isolated acts of abuse or violence
  • Being a prisoner of war

Although extremely unpleasant, these singular events occur at one time in a person’s life.

Long-term impact

Those who have PTSD can experience difficulty in their relationships with others, adopt negative thought patterns and have an obscure self-perception – they may also perceive the world completely different from others.


People with Complex PTSD are those who have got exposed to repeated trauma over months or years.

Unlike PTSD, which results from a single trauma, the disorder C-PTSD is widely different and is a result of long-term, ongoing trauma.

Ongoing trauma includes:

  • Ongoing child neglect
  • Living in a war-torn area over a long period
  • Constant emotional, physical or sexual abuse
  • Being a prisoner of war

Long-term impact

Chronic trauma can have an impact on the brain, according to studies.

A traumatic event can affect the way our brains develop and how they function, particularly on the hippocampus, prefrontal cortex and amygdala.

All these areas of the brain play a significant role in how we react to stressful situations, memory function is also likely to be impaired in someone exposed to long-term trauma.

How mental health professionals make the distinction between PTSD and Complex PTSD is understanding that while some of the symptoms of PTSD are similar to those experienced in C-PTSD, they are separate conditions.

What are the signs of C-PTSD?

The symptoms associated with C-PTSD are also associated with PTSD. However, in C-PTSD, there are additional symptoms.

Symptoms of PTSD

  • Experiencing flashbacks and nightmares: This includes reliving the traumatic event
  • Changes in your beliefs: This includes how you view yourself and others
  • Avoidance behaviour: This involves avoiding places and people associated with the trauma or event
  • Physical symptoms: When someone reminds you of an event – you might feel nauseous or dizzy
  • Hyperarousal: This is a term used to describe feelings of ‘being on edge’ or ‘jumpy’. You might find it hard to concentrate or experience insomnia

Symptoms of C-PTSD

People suffering from Complex Post Traumatic Stress will experience PTSD and Complex PTSD symptoms – these additional symptoms include:

  • Changes in awareness: This involves feeling detached from the traumatic event or forgetting the event entirely. All this can consist of feeling disconnected from your body and emotions – psychologists refer to this condition as ‘dissociation’.
  • Experiencing difficulty in relationships: You may find it hard to trust others, or avoid relationships altogether – others might get drawn to an abuser because it feels familiar.
  • Problems with emotional regulation: People who have experienced trauma may feel as though they cannot control their anger or sadness.
  • A distorted or negative self-perception: Those with C-PTSD as a result of traumatic memories tend to view themselves in a negative light. They may feel different from other people, and this can cause intense feelings of vulnerability.
  • Loss of systems of meanings: This can refer to ones’ faith associated with religion or any other form of worship. It is possible for someone exposed to long-term trauma to question any long-held beliefs – people living with C-PTSD may lose faith altogether, believing the world to be a hopeless place that is full of despair.

Additional risk factors

Like most mental health disorders, there are some factors that put some people at risk more than others. 

When it comes to C-PTSD, there is a wide range of risks involved, these include:

  • Lifestyle – including a persons’ career, mainly if it’s a job that puts them in danger and not having a stable support system
  • Genetics and inherited personality traits
  • Co-occurring mental health disorders such as anxiety, depression or addiction disorder
  • How the chemicals in our bodies react to stress and how our brain regulates hormones, particularly in stressful situations

Treatment for C-PTSD

There are plenty of treatment options for Complex Post Traumatic Stress. These treatment options include:


Those who have gone through a traumatic experience tend to view the world as a dangerous place. These views can get in the way of them having a better quality of life.

Psychotherapy sometimes referred to as ‘talk therapy’ includes talking to a therapist who can help you make sense of your past and any negative experiences. Therapy sessions are conducted on a one to one basis and usually take place once a week.

Cognitive Behavioural Therapy is another effective form of therapy, which involves a therapist helping you to identify negative thought patterns whilst giving you the coping skills and mechanisms to manage them.

Eye Movement Desensitization and Reprocessing (EMDR)

Specifically designed to treat trauma, EMDR is an effective therapy that helps to treat Traumatic Stress Disorder PTSD and C-PTSD.

EMDR involves thinking about a traumatic event or memory, whilst moving your eyes from side to side, guided, of course, by a therapist. 

Through continuous treatment, the individual will be able to process the memory, causing them the discomfort, and will eventually become desensitized to the memory or thought behind the unpleasant symptoms.


The medications used to treat depression are also useful in the treatment of CTPSD. Although, a combined approach, such as medication alongside CBT, for instance, increases the effectiveness significantly. 

Typically, patients get prescribed the following medicines to treat symptoms of C-PTSD:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)


Living with C-PTSD doesn’t have to be a way of life. Getting the right health information to make an informed decision about your treatment options is one of the best ways to begin finding the correct type of therapy and support for you.

The experiences we encounter early in life can have a massive impact on how we live our lives as adults.

At Tikvah Lake Recovery, we offer a supportive and nurturing environment for people to pursue a self-determined life – a life full of purpose and understanding – where your past doesn’t have to determine your future.

About Adam Nesenoff

Adam Nesenoff has been working in recovery for over ten years.

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